No Parent Left Behind

Often, the most effective efforts to intervene in the lives of disadvantaged children start early -- or even before they are born.

Gabby Reyes and Michael Ortiz are sitting on a couch at their house off Chicago's Fullerton Avenue on an October afternoon with their nine-day-old baby, Michael, curled up between them. Their beagle puppy, Bayle, runs across the living room. Despite the cozy domestic moment, family life came upon Reyes and Ortiz as a surprise -- and not a welcome one, either.

"We went into a doctor's office, and they're like, 'Oh, congratulations. You're pregnant,'" Reyes says. "I was like, 'No.' I was seventeen."

Ortiz, who is 18, leans forward on the couch. "I was scared," he says.

"I was confused," Reyes adds.

Reyes dropped out of Kelvyn Park High School when she learned she was pregnant. Luckily, a midwife in her doctor's office recommended a doula program. Doula is a Greek word that means, loosely, "female helper" and describes someone who assists a mother before, during, and after childbirth. Hiring a private doula may cost several thousand dollars and is usually the province of wealthy families. But innovative, community-based programs have emerged in Illinois and nine other states, and are designed to serve women like Reyes, who had hardly planned to end up pregnant at such a young age.

Nearly everyone agrees that planning for a child, rather than falling into a pregnancy accidentally, is preferable. Yet unwanted pregnancies are a distressingly familiar problem, especially in areas where young women have few opportunities for higher education and decent jobs. Better access to contraception, as well as improvements in sex education, are important parts of helping to avoid these pregnancies. But when they do occur, the community-based doula programs offer a warm and nurturing environment for the young women and their babies. The programs are part of a national effort to intervene as early as possible in the lives of children born into troubled circumstances. Allowing social workers, nurses, and community leaders into homes of families while the children are still in the womb helps establish solid foundations for the children's futures.

Doula Bridget Lally, 33, started visiting Reyes when she was in her seventh month of pregnancy. They met once a week, usually for 45 minutes, and talked about such topics as natural childbirth and breast-feeding. Once the baby was born, Lally focused on parenting skills. "Before we had a doula, we didn't know anything," says Reyes. She recalls how her family had tried to help her through childbirth. "I was screaming at them, 'You guys suck at this! I need Bridget,'" Reyes says. "She was the only one in a calm voice who was saying, 'Push.' I'm like, 'Okay.'"

Besides Reyes, Lally works with eight other girls who are pregnant or who have recently given birth, including a 14-year-old rape victim ("I call her, 'my little bird,'" Lally tells me), under the auspices of Christopher House, a Chicago family-resource center. Lally and other doulas have relied on the training and methodology provided by the Ounce of Prevention Fund, a nonprofit organization that was founded in 1982 by Chicago philanthropist Irving Harris.

Community-based doula programs have grown steadily since 1996, adding three to five sites in places around the country per year, says Rachel Abramson, executive director of Chicago Health Connection, a nonprofit agency that has worked in this field for two decades. There are now 34 programs serving 1,800 families annually. A similar program, the Nurse-Family Partnership, which assists first-time mothers, was created in 1977, according to founder David Olds, a professor of pediatrics at the University of Colorado, and now serves 13,000 families in 23 states.

The community-based doula programs and the Nurse-Family Partnership are devoted to families who face not only poverty but a range of social problems, including child abuse, substance abuse, and crime. These are just two of the better known models -- there are several other promising approaches -- but they represent a range of programs that include everything from parenting groups to counseling for young mothers who may have been victims of sexual abuse. The programs are supported by a mixture of private and state funds -- a fact that could change with the election of a new president in 2008. They have attracted the attention of Hillary Clinton and John Edwards, whose anti-poverty platform offers grants for states to replicate the home-visiting model for another 50,000 families. Barack Obama, meanwhile, has joined fellow Illinois senator Dick Durbin to earmark approximately $1.5 million in federal funds for community doula programs nationally. In addition, a diverse group of leaders in the law-enforcement, public-health, and business communities, as well as philanthropists such as J.B. Pritzker, a managing partner with the Chicago-based Pritzker Group, have supported these efforts.

"For every dollar invested in early childhood in health care and so on, you save seven to seventeen dollars in government spending over the life of these children," Pritzker tells me. "They tend not to go to jail. They stay healthy. With these programs, you have something that works." To that end, he helped found the Pritzker Consortium on Early Childhood Development last year at the University of Chicago.

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It is late afternoon at the Marillac Social Center, located in a crumbling building on Chicago's West Side. Upstairs, across from a hallway that smells like apple juice, Loretha Weisinger, a 51-year-old doula, talks with colleagues about one of their clients. "She was holding the baby like this," says Weisinger, her arms ramrod straight, imitating the 16-year-old mother. "She was saying, 'You're going to look at me whether you like it or not!'"

Weisinger says she has tried to show the mother how to hold her baby close to her chest and speak gently. She knows the challenges a teenage mother faces. At 16, Weisinger had her first child. That morning at Marillac, she says, she told the client they would teach her infant massage. "She smiled and said, 'Oh, can we do it now?' She was happy," Weisinger recalls. "It's still early, but she is easing off the harsh talk."

It is a small step, part of the detail-oriented approach to improving the lives of children and families that the community-based doula programs and the Nurse-Family Partnership offer. The two programs differ in their methods and intensity of services. The doula program features people like Weisinger, who has been trained as a labor coach but has no formal degree in the health profession, and lasts three to nine months, whereas the Nurse-Family Partnership relies on registered nurses to provide assistance, and continues for more than two years. But the goals are the same: to help first-time mothers give their children the best start in life they can provide. Both programs are steeped in 1960s idealism and have empirical data that back up claims of success.

"There is a political principle to doing this community-based model," says Chicago Health Connection's Abramson, 54, who cites radical Brazilian educator Paulo Freire, author of Pedagogy of the Oppressed. "We believe that the power to change already exists within communities. It needs to be tapped."

Nurse-Family Partnership founder Olds, 59, says he knew early on that he wanted to help people out of poverty -- partly because he had been raised on the edge of it himself, in Ohio. In the 1970s, he worked at a Baltimore day-care center where, he recalls, "I witnessed one little boy being slapped in the face and screamed at."

"I realized that for a lot of children in my classroom, it was a little late," he says. The solution, he and Abramson agree, is to reach the children long before they get to child care or school. The results are impressive.

The Nurse-Family Partnership gives taxpayers a solid return on their investment, according to Steve Aos, author of a Washington State Institute for Public Policy report on early childhood development programs. The cost of the Nurse-Family Partnership program averaged $9,118 per family in 2003, and the benefits, accrued through the prevention of crime, substance abuse, and other problems, were $26,298. In the short run, participating mothers received better prenatal care and suffered fewer risk factors. In addition, a study published in October's issue of Pediatrics, the journal of the American Academy of Pediatrics, looked at families seven years after they completed the program. It showed that mothers were less likely to have subsequent births or rely on welfare, and that their elementary school–age children earned higher grades and test scores than their peers.

On the strength of such evidence, a 2007 report by Brookings Institution scholar Julia B. Isaacs singles out the nurse home-visiting model as one that merits "expanded federal funding even in a time of fiscal austerity." It recommends an investment of $14 billion over the next five years as a way to "promote sound prenatal care and the healthy development of infants and toddlers."

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The benefits are immense -- but so are the difficulties. Many of the doulas themselves are teetering on poverty. Sitting in the Marillac conference room, doula Peggy Brewer, 45, says she is struggling to support herself and two foster children on her $10.90-an-hour salary. And the harsh reality is that Brewer and her colleagues in similar intervention programs are often trying to counteract years of abuse, neglect, and other dysfunction. She describes one client -- a 13-year-old in a ponytail -- whose mother left the delivery room momentarily and then returned with white powder on her mouth.

"Smoking crack," says doula Weisinger.

"It was grossing me out," says Brewer, rubbing the sides of her own mouth.

The girl lived in a house without a door, says Brewer, and after having her baby she would come to the center and ask for help. "The baby's hair wasn't combed," Brewer recalls.

" -- and was in soggy pants," Weisinger says.

They eventually lost track of the girl as well as many others they have tried to help. "It affects your sleep at night," Brewer says. "Some of these girls are homeless and have nowhere to go."

In many other cases, though, the young women learn how to become caring and affectionate parents. Today, Reyes is planning to study for her GED and wants to work as a dance teacher. Ortiz says he hopes someday to own a barbershop. Reyes recalls how frightened she was of giving birth and becoming a mother -- until Lally helped her through the process. "She had me write down things like, 'Go into postpartum depression' and 'Be a bad mom,' on strips of paper. I read them out loud and tore them up. I felt like I was throwing that fear away. Now I think sometimes I'm going crazy," she says, describing the exhaustion she has faced while caring for a newborn. "But I don't think I'm a bad mom."